Individual provider Active NPI

Angelita Reyes Quiroz, NP-C

  • Nurse Practitioner
  • Ellaville, GA
National Provider Identifier
1568017663
Registry record updated Aug 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN225863 Issued in GA
Practice address
339 S Broad St
Ellaville, GA 31806-3304
Phone
(229) 931-8680
Fax
(229) 937-2232
NPI assigned
Aug 6, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN225863 GA Primary

Addresses

Primary practice location

339 S Broad St
Ellaville, GA 31806-3304

Mailing address

PO Box 65
Ellaville, GA 31806-0065
Phone (229) 931-8680

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191022001954 GA Practitioner - Nurse Practitioner 3375875453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

339 S Broad St
Ellaville, GA 31806-3304
Phone (229) 931-8680

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN225863GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Phoebe Sumter Medical Center, Inc CurrentSince Aug 1, 2019 Accepting new patients
Phoebe Sumter Medical Center, Inc. CurrentSince Aug 1, 2019 Accepting new patients
Sumter Regional Hospital PastSince Aug 11, 2019 Accepting new patients

Locations

126 US Highway 280 W
Americus, GA 31719
Phone (229) 924-6011

Interoperability endpoints

  • Direct secure messaging: angelita.quiroz@phoebehealth.gadirect.net

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565049600000",
    "number": "1568017663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 65",
            "city": "ELLAVILLE",
            "state": "GA",
            "postal_code": "318060065",
            "telephone_number": "229-931-8680",
            "fax_number": "229-937-2232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 S BROAD ST",
            "city": "ELLAVILLE",
            "state": "GA",
            "postal_code": "318063304",
            "telephone_number": "229-931-8680",
            "fax_number": "229-937-2232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUIROZ",
        "first_name": "ANGELITA",
        "middle_name": "REYES",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-06",
        "last_updated": "2019-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN225863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellaville, GA

Sources for this page

Verify at the official NPI Registry.